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Hernández-Boluda JC, Pastor-Galán I, Arellano-Rodrigo E, Raya JM, Pérez-Encinas M, Ayala R, Ferrer-Marín F, Velez P, Mora E, Fox ML, Hernández-Rivas JM, Xicoy B, Mata-Vázquez MI, García-Fortes M, Pérez-López R, Angona A, Cuevas B, Senín A, Ramírez MJ, Ramírez-Payer A, Gómez-Casares MT, Martínez-Valverde C, Magro E, Steegmann JL, Durán MA, García-Hernández C, Gasior M, de Villambrosia SG, Alvarez-Larrán A, Pereira A. Predictors of thrombosis and bleeding in 1613 myelofibrosis patients from the Spanish Registry of Myelofibrosis. Br J Haematol 2022; 199:529-538. [PMID: 36089912 DOI: 10.1111/bjh.18440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/14/2022] [Accepted: 08/18/2022] [Indexed: 12/01/2022]
Abstract
Available data have proved insufficient to develop consensus recommendations on the prevention of thrombosis and bleeding in myelofibrosis (MF). We evaluated the incidence and risk factors of vascular complications in 1613 patients from the Spanish Myelofibrosis Registry. Over a total of 6981 patient-years at risk, 6.4% of the study population had at least one thrombotic event after MF diagnosis, amounting to an incidence rate of 1.65 per 100 patient-years. Prior history of thrombosis, the JAK2 mutation, and the intermediate-2/high-risk International Prognostic Scoring System (IPSS) categories conferred an increased thrombotic risk after adjustment for the risk-modifying effect of anti-thrombotic and cytoreductive treatments. History of thrombosis and the JAK2 mutation allowed us to pinpoint a group of patients at higher risk of early thrombosis. No decreased incidence of thrombosis was observed while patients were on anti-thrombotic or cytoreductive treatment. An increased risk of venous thrombosis was found during treatment with immunomodulatory agents. A total of 5.3% of patients had at least one episode of major bleeding, resulting in an incidence rate of 1.5 events per 100 patient-years. Patients in the intermediate-2/high-risk IPSS categories treated with anti-coagulants had an almost sevenfold increased risk of major bleeding. These findings should prove useful for guiding decision-making in clinical practice.
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Affiliation(s)
| | - Irene Pastor-Galán
- Hematology Department, Hospital Clínico Universitario-INCLIVA, Valencia, Spain
| | | | - José-María Raya
- Hematology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - Manuel Pérez-Encinas
- Hematology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Rosa Ayala
- Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Francisca Ferrer-Marín
- Hematology Department, Hospital Morales Meseguer, Universidad Católica San Antonio de Murcia, Centro de Investigación Biomédica en Red de Enfermedades Raras, Murcia, Spain
| | - Patricia Velez
- Hematology Department, Hospital del Mar, Barcelona, Spain
| | - Elvira Mora
- Hematology Department, Hospital Universitario La Fe, Valencia, Spain
| | - María-Laura Fox
- Hematology Department, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | | | - Blanca Xicoy
- Hematology Department, Hospital Germans Trias i Pujol, Institut Català d'Oncologia, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | | | - María García-Fortes
- Hematology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Raúl Pérez-López
- Hematology Department, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Anna Angona
- Hematology Department, Hospital Josep Trueta, Institut Català d'Oncologia, Girona, Spain
| | - Beatriz Cuevas
- Hematology Department, Hospital Universitario de Burgos, Burgos, Spain
| | - Alicia Senín
- Hematology Department, Hospital Duran i Reynals, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - María-José Ramírez
- Hematology Department, Hospital General Jerez de la Frontera, Cádiz, Spain
| | | | | | | | - Elena Magro
- Hematology Department, Hospital Príncipe de Asturias, Alcalá de Henares, Spain
| | | | | | | | | | | | - Alberto Alvarez-Larrán
- Hematology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Arturo Pereira
- Department of Hemotherapy and Hemostasis, Hospital Clínic, Barcelona, Spain
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Haddad A, Saliba W, Lavi I, Batheesh A, Kasem S, Gazitt T, Feldhamer I, Cohen AD, Zisman D. The Association of Psoriatic Arthritis With All-cause Mortality and Leading Causes of Death in Psoriatic Arthritis. J Rheumatol 2021; 49:165-170. [PMID: 34266988 DOI: 10.3899/jrheum.210159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the association between psoriatic arthritis (PsA) and all-cause mortality from a large population-based database. METHODS Patients with PsA from the Clalit Health Services database were identified between 2003-2018 and matched to 4 controls by age, sex, ethnicity, and index date. Patient demographics, comorbidities, and treatments were extracted. Mortality data were obtained from the Israeli Notification of Death certificate. The proportionate mortality rate (PMR) of the leading causes of death was calculated and compared to that of the general population. Cox proportional hazard regression models were used to estimate the crude and the multivariate adjusted HR for the association between PsA and all-cause mortality and for factors associated with mortality within the PsA group. RESULTS There were 5275 patients with PsA and 21,011 controls included and followed for 7.2 ± 4.4 years. The mean age was 51.7 ± 15.4 years, and 53% were females. Among patients with PsA, 38.2% were on biologics. Four hundred seventy-one (8.9%) patients died in the PsA group compared to 1668 (7.9%) in the control group. The crude HR for the association of PsA and all-cause mortality was 1.16 (95% CI 1.04-1.29) and 1.02 (95% CI 0.90-1.15) on multivariate analysis. Malignancy was the leading cause of death (26%), followed by ischemic heart disease (15.8%); this is in keeping with the leading causes of death in the general population. Older age, male sex, lower socioeconomic status, increased BMI, increased Charlson comorbidity index scores, and history of psoriasis or hospitalization in 1 year prior to entry were positive predictors for mortality. CONCLUSION No clinically relevant increase in mortality rate was observed in patients with PsA, and specific PMRs were similar to those of the general population.
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Affiliation(s)
- Amir Haddad
- A. Haddad, MD, T. Gazitt, MD, MSc, Division of Rheumatology, Carmel Medical Center, Haifa; W. Saliba, MD, Department of Internal Medicine, Carmel Medical Center, and Department of Epidemiology, Clalit Health Services, Haifa; I. Lavi, MPH, Department of Internal Medicine, Carmel Medical Center, Haifa; A. Batheesh, MD, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa; S. Kasem, MD, PhD, Department of Epidemiology, Clalit Health Services, and Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa; I. Feldhamer, BSc, A.D. Cohen, MD, Clalit Health Services, Tel Aviv; D. Zisman, MD, Division of Rheumatology, Carmel Medical Center, and Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. A. Haddad and W. Saliba contributed equally to this work. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. A. Haddad, Rheumatology Unit, Carmel Medical Centre, 7 Michal Street, Haifa, 3436212 Israel. . Accepted for publication June 30, 2021
| | - Walid Saliba
- A. Haddad, MD, T. Gazitt, MD, MSc, Division of Rheumatology, Carmel Medical Center, Haifa; W. Saliba, MD, Department of Internal Medicine, Carmel Medical Center, and Department of Epidemiology, Clalit Health Services, Haifa; I. Lavi, MPH, Department of Internal Medicine, Carmel Medical Center, Haifa; A. Batheesh, MD, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa; S. Kasem, MD, PhD, Department of Epidemiology, Clalit Health Services, and Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa; I. Feldhamer, BSc, A.D. Cohen, MD, Clalit Health Services, Tel Aviv; D. Zisman, MD, Division of Rheumatology, Carmel Medical Center, and Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. A. Haddad and W. Saliba contributed equally to this work. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. A. Haddad, Rheumatology Unit, Carmel Medical Centre, 7 Michal Street, Haifa, 3436212 Israel. . Accepted for publication June 30, 2021
| | - Idit Lavi
- A. Haddad, MD, T. Gazitt, MD, MSc, Division of Rheumatology, Carmel Medical Center, Haifa; W. Saliba, MD, Department of Internal Medicine, Carmel Medical Center, and Department of Epidemiology, Clalit Health Services, Haifa; I. Lavi, MPH, Department of Internal Medicine, Carmel Medical Center, Haifa; A. Batheesh, MD, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa; S. Kasem, MD, PhD, Department of Epidemiology, Clalit Health Services, and Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa; I. Feldhamer, BSc, A.D. Cohen, MD, Clalit Health Services, Tel Aviv; D. Zisman, MD, Division of Rheumatology, Carmel Medical Center, and Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. A. Haddad and W. Saliba contributed equally to this work. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. A. Haddad, Rheumatology Unit, Carmel Medical Centre, 7 Michal Street, Haifa, 3436212 Israel. . Accepted for publication June 30, 2021
| | - Amin Batheesh
- A. Haddad, MD, T. Gazitt, MD, MSc, Division of Rheumatology, Carmel Medical Center, Haifa; W. Saliba, MD, Department of Internal Medicine, Carmel Medical Center, and Department of Epidemiology, Clalit Health Services, Haifa; I. Lavi, MPH, Department of Internal Medicine, Carmel Medical Center, Haifa; A. Batheesh, MD, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa; S. Kasem, MD, PhD, Department of Epidemiology, Clalit Health Services, and Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa; I. Feldhamer, BSc, A.D. Cohen, MD, Clalit Health Services, Tel Aviv; D. Zisman, MD, Division of Rheumatology, Carmel Medical Center, and Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. A. Haddad and W. Saliba contributed equally to this work. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. A. Haddad, Rheumatology Unit, Carmel Medical Centre, 7 Michal Street, Haifa, 3436212 Israel. . Accepted for publication June 30, 2021
| | - Samir Kasem
- A. Haddad, MD, T. Gazitt, MD, MSc, Division of Rheumatology, Carmel Medical Center, Haifa; W. Saliba, MD, Department of Internal Medicine, Carmel Medical Center, and Department of Epidemiology, Clalit Health Services, Haifa; I. Lavi, MPH, Department of Internal Medicine, Carmel Medical Center, Haifa; A. Batheesh, MD, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa; S. Kasem, MD, PhD, Department of Epidemiology, Clalit Health Services, and Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa; I. Feldhamer, BSc, A.D. Cohen, MD, Clalit Health Services, Tel Aviv; D. Zisman, MD, Division of Rheumatology, Carmel Medical Center, and Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. A. Haddad and W. Saliba contributed equally to this work. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. A. Haddad, Rheumatology Unit, Carmel Medical Centre, 7 Michal Street, Haifa, 3436212 Israel. . Accepted for publication June 30, 2021
| | - Tal Gazitt
- A. Haddad, MD, T. Gazitt, MD, MSc, Division of Rheumatology, Carmel Medical Center, Haifa; W. Saliba, MD, Department of Internal Medicine, Carmel Medical Center, and Department of Epidemiology, Clalit Health Services, Haifa; I. Lavi, MPH, Department of Internal Medicine, Carmel Medical Center, Haifa; A. Batheesh, MD, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa; S. Kasem, MD, PhD, Department of Epidemiology, Clalit Health Services, and Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa; I. Feldhamer, BSc, A.D. Cohen, MD, Clalit Health Services, Tel Aviv; D. Zisman, MD, Division of Rheumatology, Carmel Medical Center, and Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. A. Haddad and W. Saliba contributed equally to this work. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. A. Haddad, Rheumatology Unit, Carmel Medical Centre, 7 Michal Street, Haifa, 3436212 Israel. . Accepted for publication June 30, 2021
| | - Ilan Feldhamer
- A. Haddad, MD, T. Gazitt, MD, MSc, Division of Rheumatology, Carmel Medical Center, Haifa; W. Saliba, MD, Department of Internal Medicine, Carmel Medical Center, and Department of Epidemiology, Clalit Health Services, Haifa; I. Lavi, MPH, Department of Internal Medicine, Carmel Medical Center, Haifa; A. Batheesh, MD, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa; S. Kasem, MD, PhD, Department of Epidemiology, Clalit Health Services, and Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa; I. Feldhamer, BSc, A.D. Cohen, MD, Clalit Health Services, Tel Aviv; D. Zisman, MD, Division of Rheumatology, Carmel Medical Center, and Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. A. Haddad and W. Saliba contributed equally to this work. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. A. Haddad, Rheumatology Unit, Carmel Medical Centre, 7 Michal Street, Haifa, 3436212 Israel. . Accepted for publication June 30, 2021
| | - Arnon Dov Cohen
- A. Haddad, MD, T. Gazitt, MD, MSc, Division of Rheumatology, Carmel Medical Center, Haifa; W. Saliba, MD, Department of Internal Medicine, Carmel Medical Center, and Department of Epidemiology, Clalit Health Services, Haifa; I. Lavi, MPH, Department of Internal Medicine, Carmel Medical Center, Haifa; A. Batheesh, MD, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa; S. Kasem, MD, PhD, Department of Epidemiology, Clalit Health Services, and Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa; I. Feldhamer, BSc, A.D. Cohen, MD, Clalit Health Services, Tel Aviv; D. Zisman, MD, Division of Rheumatology, Carmel Medical Center, and Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. A. Haddad and W. Saliba contributed equally to this work. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. A. Haddad, Rheumatology Unit, Carmel Medical Centre, 7 Michal Street, Haifa, 3436212 Israel. . Accepted for publication June 30, 2021
| | - Devy Zisman
- A. Haddad, MD, T. Gazitt, MD, MSc, Division of Rheumatology, Carmel Medical Center, Haifa; W. Saliba, MD, Department of Internal Medicine, Carmel Medical Center, and Department of Epidemiology, Clalit Health Services, Haifa; I. Lavi, MPH, Department of Internal Medicine, Carmel Medical Center, Haifa; A. Batheesh, MD, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa; S. Kasem, MD, PhD, Department of Epidemiology, Clalit Health Services, and Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa; I. Feldhamer, BSc, A.D. Cohen, MD, Clalit Health Services, Tel Aviv; D. Zisman, MD, Division of Rheumatology, Carmel Medical Center, and Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. A. Haddad and W. Saliba contributed equally to this work. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. A. Haddad, Rheumatology Unit, Carmel Medical Centre, 7 Michal Street, Haifa, 3436212 Israel. . Accepted for publication June 30, 2021
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